University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS, Australia.
University of Tasmania, Menzies Institute for Medical Research, Hobart, TAS, Australia.
Lancet Planet Health. 2024 Oct;8(10):e744-e753. doi: 10.1016/S2542-5196(24)00207-9.
Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.
Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots-points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially-were estimated and countries in the vicinity of these knots identified.
Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.
Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries-low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.
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在低收入国家增加卫生支出与健康状况的迅速改善有关。然而，人们对卫生支出水平较高时边际收益递减的可能性，以及医疗保健温室气体排放与结果之间的关系关注较少。本研究旨在调查卫生保健支出和排放边际收益递减的存在、规模和影响。
采用分段（分段）回归分析，探讨全球疾病负担项目（可通过医疗保健改善的死亡率[MAH]和健康调整预期寿命[HALE]）两个健康结果指标与世界卫生组织全球卫生支出数据库中人均卫生支出的四个总和以及人均卫生保健部门温室气体排放量之间的关系，这些排放量来自 Lenzen 及其同事在 2020 年的一项研究。估计了转折点（弹性或递增回报的变化点），并确定了接近这些转折点的国家。
在低收入和中下收入国家，卫生支出的快速递增回报（以 MAH 和 HALE 衡量的人口健康改善）被估计；在人均支出水平超过约 500 美元后，这些回报开始放缓。在人均支出水平高于意大利等高收入国家（约 3400 美元）时，几乎没有或没有证据表明额外支出或增加医疗保健温室气体排放会带来进一步的健康回报。
在低收入国家增加卫生支出可以显著改善人口健康结果。相反，高收入国家卫生支出的持续增长本身不太可能带来健康结果的快速改善。我们的研究结果为正在进行的关于在行星边界内达到足够水平的重要性的辩论提供了信息——低收入国家需要快速增长卫生支出，而高收入国家可以在资源利用水平显著降低的情况下实现更好的健康结果。
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